Combined boric acid and cinchocaine chloride poisoning in a 12-month-old infant: evaluation of haemodialysis

Usefulness of forced diuresis for acute boric acid poisoning in an adult

BACKGROUND

Boric acid is generally not recognized as a poisonous substance. However, boric acid has potentially fatal actions such as hypotension, metabolic acidosis and oliguria. Death may result from circulation collapse and shock.

OBJECTIVE

We present a clinical case history of the successful use of forced diuresis with furosemide and intravenous fluid for boric acid poisoning.

SUBJECT

A 26-year-old female who attempted suicide by consuming a large quantity of boric acid. She was brought to the hospital in a state of clouded consciousness, fever and erythema 14 h after ingestion.

METHOD

3.25 L of intravenous fluid and 100 mg of furosemide were administered over a period of 4 h in the intensive care unit and the serum and urinary concentrations of boric acid measured.

RESULTS

The elimination rate of boric acid obtained with diuresis was similar to that obtained with haemodialysis on a previous occasion when the same patient attempted suicide with boric acid. The patient showed only temporary emesis and diarrhoea along with erythema, and was moved to the general ward 4 h after admission. Although in the general ward the patient's fever persisted and nausea, vomiting and headache often recurred, possibly because of an insufficient dose of furosemide, the patient's condition steadily improved over the 64 h after admission.

CONCLUSION

Forced diuresis without haemodialysis is recommended early after admission for boric acid poisoning.

An assessment of boric acid and borax using the IEHR Evaluative Process for Assessing Human Developmental and Reproductive Toxicity of Agents. Expert Scientific Committee

BACKGROUND

Boron is a ubiquitous element widely distributed in nature in the form of borates at low concentrations in soils and rocks. Boron is released from these minerals by the natural weathering processes in the form of boric acid, which is water soluble and biologically available. High levels of boric acid are naturally found in sea water. Boric acid and borax are used in the greatest quantities and represent the major boron chemical exposures to humans and the environment. The principal use of boric acid and borax is in the manufacture of various types of glass products that do not result in exposure to the consumer. Boric acid and borax are also found in an array of consumer goods including fireproofing for fabrics and wood, insecticides, and in many cosmetics and personal care products as well. Boron may be an essential element for higher animals including humans.

HUMAN EXPOSURE

Boric acid and borax are considered to be completely absorbed by the oral route of exposure. Absorption through intact skin is considered negligible, although absorption can occur through denuded or irritated skin. Boron levels in the body do not persist upon cessation of exposure. People may be exposed to boron through three primary sources: 1) consumption of private, municipal, or commercial (bottled) sources of drinking water; 2) dietary consumption of crops and other foodstuffs (including dietary supplements for body building); and 3) inhalation of boron compounds during their mining, manufacturing, and other industrial processing. While boron has been detected in 81.8% of the municipal water systems, it is a minor source of boron in most parts of the U.S. The mean boron concentration is reported as 0.2 mg B/L. However, residents of California and other western states with boron-rich geologic deposits may be regularly exposed to higher levels in drinking water. Individuals who drink bottled mineral water may also increase their exposure to boron. An EPA health advisory, recommends boron concentrations in drinking water not exceed 0.6 mg B/L [0.06 mM B] over a lifetime of exposure. Dietary exposure to boron for an adult typically ranges from ranges from 0.25 to 3.1 mg B/d with an average of 1.5 mg B/d. The high end of the exposure range, 3.1 mg B/d, was selected by the Expert Committee as best estimate of exposure. It should be noted that a diet high in fruits, vegetables, grains, legumes, and other food stuffs with high boron contents may lead to daily exposures as high as 10 mg B/d from diet alone. Some body building supplements contain boron at levels ranging from 1.5 to 10 mg B, with a median of 4 mg B. Use of the supplements containing the median concentration of boron could equal the daily intake an individual receives from diet and drinking water combined. Adults in the U.S. at the high end of the food exposure range may typically ingest up to 3.5 mg B/d, or a daily dose of 0.005 mmol B/kg b.wt., through exposure from diet (3.1 mg B/d) and drinking water (0.4 mg B/d). Individuals who also use body-building supplements may have a total daily boron intake of 7.5 mg B resulting in a daily dose of 0.01 mmol B/kg b.wt./d. Occupational exposure to boron is mainly through inhalation of borate containing dust during mining and manufacturing processes. Current occupational exposures to boron are reported to result in a daily dose of < 0.0001 to 0.2 mmol B/kg b.wt./d. Current U.S. OSHA permissible exposure limit (PEL) for sodium tetraborates is 10 mg/m3, and the California Occupational Safety and Health Administration PEL is 5 mg/m3. An exposure of 5 mg B/m3 translates to approximately 0.01 mmol B/kg b.wt./d that, coincidentally, is the same as exposure levels associated with combined municipal drinking water, diet, and body building supplement consumption. Infants may receive exposures to boric acid when it is used as a household insecticide for cockroach control. Exposure from boric acid-containing cosmetic and personal care products applie